What are the causes of compartment syndrome?

From the Guidelines

Compartment syndrome is primarily caused by increased pressure within a confined anatomical space, leading to compromised blood flow and potential tissue damage, with the main causes including trauma, tight bandages or casts, burns, prolonged limb compression, excessive exercise, vascular injuries, reperfusion injury, snake bites, and bleeding disorders. The causes of compartment syndrome can be categorized into several key areas, including:

• Trauma: Fractures, crush injuries, or severe bruising can cause swelling and bleeding within a compartment, as noted in studies such as 1 and 1.
• Tight bandages or casts: Improperly applied or overly tight dressings can restrict blood flow and increase pressure, as discussed in 1.
• Burns: Severe burns can cause fluid shifts and swelling in affected limbs, leading to increased pressure within compartments, as mentioned in 1 and 1.
• Prolonged limb compression: Extended periods of immobility, especially in unconscious patients, can lead to compartment syndrome, as highlighted in 1 and 1.
• Excessive exercise: Intense physical activity, particularly in untrained individuals, can cause muscle swelling and increased compartment pressure, as noted in 1 and 1.
• Vascular injuries: Damage to blood vessels can cause bleeding into a compartment, leading to increased pressure, as discussed in 1 and 1.
• Reperfusion injury: Sudden restoration of blood flow after prolonged ischemia can cause rapid swelling, as mentioned in 1 and 1.
• Snake bites: Certain venomous snake bites can cause severe localized swelling, leading to compartment syndrome, as noted in 1 and 1.
• Bleeding disorders: Conditions that impair blood clotting can lead to excessive bleeding into compartments, as discussed in 1 and 1. To prevent compartment syndrome, it's crucial to monitor for early signs such as severe pain, pallor, paresthesia, and decreased pulse in affected limbs, and prompt recognition and treatment, often involving fasciotomy (surgical decompression), are essential to prevent permanent tissue damage and potential limb loss, as emphasized in 1, 1, 1, 1, and 1.

From the Research

Causes of Compartment Syndrome

• Compartment syndrome can occur due to various mechanisms of injury, including:
  • Crushing or twisting injuries 2
  • Circumferential burns 2
  • Ischemia 2
  • Tourniquets 2
  • Fractures 3, 4, 5
  • Crush injuries 3, 6
  • Arterial injuries 3
  • Trauma to the extremities 3, 5
• Compartment syndrome can also be caused by non-traumatic events, such as:
  • Prolonged compression of a limb 2
  • Improper casting or splinting of a damaged extremity 2
• Certain patient populations are at higher risk of developing compartment syndrome, including:
  • Motorcyclists who suffer lower-extremity injuries in accidents 2
  • Patients with traumatic rhabdomyolysis, including those with crush syndrome and compartment syndrome 6
  • Patients who are "found down" due to opioid overdoses 6

Risk Factors

• The presence of certain risk factors can increase the likelihood of developing compartment syndrome, including:
  • Decreased perfusion within a compartment 5
  • Increased pressure within a closed compartment 5
  • Soft tissue injury 4
  • Fracture-related injury 4
• The absence of certain risk factors does not rule out the diagnosis of compartment syndrome, and a high index of suspicion is necessary to make the diagnosis 5

Pathophysiology

• Compartment syndrome occurs when the tissue pressure within a closed anatomic space is greater than the perfusion pressure, leading to:
  • Decreased blood flow to the affected area 2
  • Increased pressure within the compartment 2
  • Nerve and muscle necrosis 3
  • Permanent functional impairment and potentially life-threatening complications if left untreated 2, 3